Tums PRN Dosage for Heartburn
For occasional heartburn, take 2-4 chewable Tums tablets (750 mg calcium carbonate each) as needed, but do not exceed 5 tablets in 24 hours or use maximum dosing for more than 2 weeks without physician supervision. 1
Standard Dosing Parameters
- Each chewable tablet contains 750 mg calcium carbonate 1
- Maximum daily limit: 5 tablets per 24-hour period 1
- Duration limit: Do not use maximum dosage for more than 2 weeks without medical advice 1
- Common side effect: Constipation may occur with use 1
When Tums is NOT the Right Choice
If you have frequent heartburn (≥2 days per week for several weeks), Tums is inadequate and you should switch to a proton pump inhibitor (PPI) instead. 2, 3 Here's why:
- Antacids like Tums only transiently neutralize acid already in the esophagus but do not prevent subsequent heartburn episodes or significantly affect gastric pH 4
- PPIs provide sustained inhibition of gastric acid production and are superior to antacids for control of gastric acid and treatment of frequent heartburn 4
- A therapeutic trial with a PPI (such as omeprazole 20 mg or pantoprazole 40 mg once daily before breakfast) is the recommended initial diagnostic approach for suspected GERD 5, 2, 3
Clinical Algorithm for Heartburn Management
Step 1: Assess frequency
- Occasional heartburn (<2 days/week): Tums PRN is appropriate 1
- Frequent heartburn (≥2 days/week): Start PPI therapy, not antacids 2, 3, 4
Step 2: If starting PPI therapy
- Begin with standard once-daily PPI (pantoprazole 40 mg or omeprazole 20 mg) taken 30 minutes before first meal for 4-8 weeks 2, 3
- If inadequate response after 4-8 weeks, escalate to twice-daily dosing (before breakfast and dinner) 2, 3
- Treatment is considered successful if there is ≥75% reduction in symptom frequency 2
Step 3: For persistent symptoms on twice-daily PPI
- Perform pH/impedance monitoring while continuing the medication to determine if you have inadequate acid suppression, non-acid reflux, or hypersensitive esophagus 2
- Only 7% of patients with heartburn have persistent acid exposure on twice-daily PPIs 2
Special Considerations for Kidney Disease
If you have kidney disease, use Tums with extreme caution or avoid it entirely. While not explicitly stated in the provided evidence, calcium carbonate can cause hypercalcemia and calcium-alkali syndrome, particularly problematic in patients with impaired renal function. Consider alternative therapies like PPIs, which do not carry this risk.
Why Tums Works (and Its Limitations)
- Calcium carbonate rapidly neutralizes esophageal acid 6
- Released calcium may improve esophageal peristalsis and acid clearance by increasing proximal esophageal contractile amplitude 6
- However, antacid gum formulations provide faster and more prolonged symptom relief (up to 120 minutes) compared to chewable tablets 7
- Standard chewable antacids like Tums are inferior to H2-receptor antagonists (ranitidine) and PPIs for sustained heartburn control 8, 4
Common Pitfalls to Avoid
- Do not use Tums as chronic therapy for frequent heartburn—this delays appropriate diagnosis and treatment with PPIs 2, 3, 4
- Do not exceed the 5-tablet daily maximum or use maximum dosing beyond 2 weeks without physician supervision 1
- Do not assume all heartburn requires acid neutralization—up to 60% of PPI-refractory patients have functional heartburn or reflux hypersensitivity requiring alternative therapy 2, 3
- Do not combine Tums with H2-receptor antagonists chronically—H2RAs develop tolerance within days and provide no additional benefit when combined with PPIs 3